Sponsored by West Monroe Partners
Written by Greg Poffenroth (email@example.com) and Stuart Siegel (firstname.lastname@example.org)
Health plans have long been in the business of administration, but that model is changing rapidly. West Monroe Partners, a business and technology consulting firm, facilitates these rapid changes with their clients. Health plans are in a unique position to be industry leaders in consumer engagement because of their 360-degree view of each member. Health plans need to improve access to quality care and maintaining good health by performing roles that have historically fallen to providers, or to members themselves. Doing this requires specialized knowledge – West Monroe Partners’ unique blend of business and technology expertise allows them to work with health organizations at every step of the way on becoming an industry leader.
Digitally mature health plans are improving member experience and satisfaction through information-rich, secure, “omnichannel” (portals, websites, mobile apps, etc.) communication that offers choice, self-service, transparency, and simplified interactions. By doing so, these leaders are also reducing costs in areas such as call-center operations, inbound vendor processing, and outbound print correspondence.
While most health plans recognize the opportunities of a member-centric, omnichannel experience, their culture and business processes pose obstacles to achieving it. Like legacy companies across industries, many operate in functional “silos,” with limited coordination and fragmented data and systems that require complex hand-offs between tasks and produce inconsistent and sometimes redundant member communication. Furthermore, they rely on outdated and inefficient – often paper-based – communication channels and focus inwardly on internal improvement metrics rather than on improving the experience of members. All of these factors can complicate a member’s “journey” of doing business with the organization.
Our 4 keys to driving change
With the help of West Monroe Partners, health plans can capitalize on four lessons that trailblazers in technology, finance and other sectors have learned and the methods they have pioneered to deliver expanded and better services at lower costs.
1. Establish and communicate a clear vision
It is very hard to change unless the organization has clearly defined its “destination” and ensured that all stakeholders understand what that destination is. Therefore, a health plan must be able to articulate how it intends to harness the power of digital communication within an omnichannel architecture. This “North Star” should be the result of outside-in research that provides an intimate understanding of key member touchpoints and pain points. Research should include interviews, surveys, persona building, and journey mapping.
2. Redesign operations and talent requirements
Once the organization establishes its North Star, it will need to assess current operations to identify the projects necessary for making that vision a reality. Not all change can occur simultaneously. Planning and prioritization should balance consumer and business impact and consider factors such as cost, risk, technology needs, dependencies, and impact to operations.
This change will require new types of talent with a member-centric ethos and the ability to discern customer needs and be creative about crafting experiences on digital and traditional channels. A talent and skills assessment can identify current strengths and skill gaps.
3. Embrace a new way of working
When an organization is structured by function (e.g., product development, marketing, claims, service, finance, provider network management), employees tend to see and touch only a part of the member experience. This stands in the way of delivering a true, member-centric experience. Health plans must upend this approach. Instead, they should strive to organize employees, processes and incentives around aspects of the member experience (e.g., onboarding, member services, clinical pathways) – just as agile, digital organizations do, tasking “pods” staffed by specialists in business, process, customer experience, technology, and data with building specific capabilities. This paves the way to continuous improvement and evolution of the overall member experience.
Because this is a fundamental change to the way people work, it is important to align incentives with transformation goals and have clear, well-publicized key performance indicators that stress the importance of member-centric behavior.
4. Harness the organization’s wealth of data to improve member relations and health outcomes
Once the organization begins to operate across functional boundaries, it will become easier and easier to harness data to change the member experience. For example, better access to data can help tailor communication to a member’s specific point in the care journey, predict upcoming needs based on historical population experience, or identify emerging operational issues that affect the member journey. An organization can also use next-best-action analytics to arm customer service reps with useful insights into why a member may be calling, based on previous interactions across channels.
To avoid overwhelming teams and stakeholders, it is best to start small and resist the temptation to make too many changes at once. Focusing on a few priorities can go a long way toward making an omnichannel, member-focused vision a reality.
About West Monroe Partners
West Monroe is a national business and technology consulting firm that partners with dynamic organizations to reimagine, build, and operate their businesses at peak performance. Our team of more than 1,400 professionals across nine offices is comprised of an uncommon blend of business consultants and deep technologists. This unique combination of expertise enables us to design, develop, implement, and run strategic business and technology solutions that yield a dramatic commercial impact on our clients’ profitability and performance. For more information, visit www.wmp.com.